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O&G: Gynaecology > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is a miscarriage?

A

Foetus dies or delivers dead before 24 completed weeks of pregnancy. Majority occur before 12 weeks.

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2
Q

What type of miscarriage is this describing?
Bleeding but the foetus is still alive. Uterus is the size expected for the dates and cervical os is closed. Only 25 % miscarry.

A

Threatened

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3
Q

What type of miscarriage is this describing?

Heavier bleeding. Foetus may still be alive, cervical os is open. Miscarriage is about to occur.

A

Inevitable

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4
Q

What type of miscarriage is this describing?

Some foetal parts have passed, cervical os is open.

A

Incomplete

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5
Q

What type of miscarriage is this describing?

All foetal tissue has passed. Bleeding diminished, uterus is no longer enlarged and os is closed.

A

Complete

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6
Q

What type of miscarriage is this describing?
Foetus has not developed or has died in utero, not recognised until bleeding occurs or USS performed. Uterus is smaller than expected for dates and os is closed.

A

Missed

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7
Q

What are the causes of a miscarriage?

A
  1. Chromosomal abnormalities

2. >3 miscarriages = recurrent and must be investigated

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8
Q

What are the main clinical features of miscarriage?

A
  1. PV bleeding - unless incidental finding

2. Pain from uterine contractions - can be confused with ectopic

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9
Q

How is a suspected miscarriage investigated?

A
  1. USS
  2. Speculum to visualise os
  3. hCG
  4. FBC, G+C, RhD status
  5. Fever - swabs for culture, IV antibiotics
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10
Q

What are the different results of a bhCG measurement?

A
  1. Viable intrauterine pregnancy - rises >63% in 48 hours
  2. Ectopic - between 50% fall and 63% rise in 48 hours (plateauing)
  3. Non-viable pregnancy - decline of >50% in 48 hours
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11
Q

What is the immediate emergency management for a miscarriage?

A
  1. Resuscitation if haemodynamically shocked
  2. Remove products of conception in cervical os with forceps
  3. Anti-D for RhD-ve if needing medical/surgical treatment
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12
Q

What is the expectant management of a miscarriage?

A
  1. If not bleeding heavily, effective for incomplete miscarriage.
  2. Rescan in 2 weeks to ensure complete
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13
Q

What is the medical management for a miscarriage?

A
  1. Mifepristone (anti-progestogen), and misoprostol 24-48 hours later
  2. Bleeding may continue for 3 weeks after
  3. Good for incomplete and missed miscarriage under 9 weeks gestational age
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14
Q

What is the surgical management for a miscarriage?

A
  1. If heavy/persistent bleeding >2 weeks or patient choice
  2. Under general anaesthetic using vacuum aspiration/ERPC under 13 weeks gestational age
  3. Very successful in incomplete and missed miscarriage
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15
Q

What are the complications of miscarriage?

A
  1. Heavy and painful PV bleeding with expectant and medical management
  2. Risk with expectant and medical management to need surgical switch
  3. Infection, septic shock
  4. Asherman’s syndrome (scar tissue in uterus)
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16
Q

What are the appropriate points for counselling a patient who has had a miscarriage?

A
  1. Allow time and space to grieve
  2. Not a result of anything they have done
  3. Could not be prevented
  4. Reassure as to a high chance of future successful pregnancies
  5. Supportive services
  6. Further investigation usually for >3 miscarriages or miscarry >12/40.
17
Q

What is a recurrent miscarriage?

A

Loss of 3 or more consecutive pregnancies before 24 weeks with the same biological father.

18
Q

What are the endocrine causes of recurrent miscarriage?

A

Thyroid, PCOS, poorly controlled diabetes mellitus

19
Q

What are the immune causes of recurrent miscarriage?

A

High NK cells, treatment with prednisolone

20
Q

What is the common infection cause of recurrent miscarriage?

A

BV associated with second trimester loss

21
Q

How are parental chromosomal abnormalities investigated in recurrent miscarriage?

A
  1. Foetal tissue karyotyped and if unbalanced, karyotype both parents.
  2. Refer to clinical geneticist
  3. Prenatal diagnosis using CVS/amniocentesis can be offered
  4. Preimplantation genetic diagnosis in IVF could be tried
22
Q

How are uterine abnormalities investigated in recurrent miscarriage?

A

Pelvic USS + MRI/HSG if abnormal

23
Q

What is the treatment for antiphospholipid syndrome as a cause of recurrent miscarriage?

A
  1. If Abs +ve on 2 separate occasions 12 weeks apart
  2. Give aspirin 75mg PO from day 1 of +ve pregnancy test and LMWH as soon as foetal heart is seen until delivery.
  3. Refer to specialist
24
Q

What is the treatment for thrombophilia as a cause of recurrent miscarriage?

A

LMWH

25
Q

What are some lifestyle causes of recurrent miscarriage?

A

Obesity, smoking, excess caffeine

O&G: Gynaecology (48 decks)

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